Comparison between posterior lumbar fusion with pedicle screws and posterior lumbar interbody fusion with pedicle screws in adult spondylolisthesis

Abstract

-The purpose of this study was to compare patients with lumbar spondylolisthesis submitted to two different surgical approaches, and evaluate the results and outcomes in both groups. In a two-year period, 60 adult patients with lumbar spondylolisthesis, both isthmic and degenerative, were submitted to surgery at the Biocor Institute, Brazil. All patients were operated on by the same surgeon (FLRD) in a single institution, and the results were analyzed prospectively. Group I comprised the first 30 consecutive patients that were submitted to a posterior lumbar spinal fusion with pedicle screws (PLF). Group II comprised the last 30 consecutive patients submitted to a posterior lumbar interbody fusion procedure (PLIF) with pedicle screws. All patients underwent foraminotomy for nerve root decompression. Clinical evaluation was carried out using the Prolo Economic and Functional Scale and the Rolland-Morris and the Oswestry questionnaire. Mean age was 52.4 for Group I (PLF), and 47.6 for Group II (PLIF). The mean follow-up was 3.2 years. Both surgical procedures were effective. The PLIF with pedicle screws group presented better clinical outcomes. Group I presented more complications when compared with Group II. Group II presented better results as indicated in the Prolo Economic and Functional Scale.KEy wORDS: posterior lumbar interbody fusion (PLIF), posterior lumbar fusion, spondylolisthesis, pedicle screws, lumbar spine, spinal instrumentation.estudo comparativo entre fusão lombar posterior com parafuso pedicular e fusão intersomáti-ca lombar posterior associada com parafuso pedicular em espondilolistese no adulto RESUMO -O objetivo foi comparar dois grupos de pacientes portadores de espondilolistese lombar que foram submetidos a dois procedimentos cirúrgicos distintos, avaliando os resultados clínicos levando em consideração a qualidade de vida. Durante o período de 1998 a 2001 sessenta pacientes portadores de espondilolistese da coluna lombar ístmica e degenerativa foram submetidos a tratamento cirúrgico no Hospital Biocor em Belo Horizonte, por um mesmo cirurgião foram analisados prospectivamente. Os primeiros trinta pacientes foram submetidos a fusão posterior com parafusos pediculares e os trinta seguintes a fusão posterior com parafusos pediculares associada a fusão intersomática posterior. Os pacientes foram submetidos a liberação radicular com laminectomia e foraminotomia. A avaliação clínica foi feita utilizando as escalas de Prolo Econômico e Funcional, o questionário de Rolland-Morris e de Oswestry. Os resultados clínicos apresentaram que os dois procedimentos realizados foram eficazes. Houve maior número de complicações relacionadas com a biomecânica no grupo que foi submetido somente à fusão posterior e o grupo submetido à fusão posterior associada a fusão intersomática apresentou melhores resultados com retorno as atividades diárias e melhora da qualidade de vida.PALAvRAS-CHAvE: fusão intersomática lombar posterior, fusão lombar posterior, espondilolistese, fixação pedicular, coluna lombar,...

Posterior lumbar interbody fusion versus posterolateral fusion in spondylolisthesis: a prospective controlled study in the Han nationality

“…Dantas et al [4] conducted a study of 60 adult lumbar spondylolisthesis patients. The patients were divided into two groups.…”

Results of instrumented posterolateral fusion in treatment of lumbar spondylolisthesis with and without segmental kyphosis: A retrospective investigation

“…[34] However, the need for additional anterior column support for low-grade displacement is debatable since various clinical outcomes have been reported. [32,[34][35][36][37][38][39][40] Kim et al compared PLF, posterior lumbar interbody fusion (PLIF), and PLIF in combination with PLF in a recent prospective randomized study on degenerative lumbar diseases and concluded that there were no significant differences in the clinical results and union rates. [37] In a study by William et al as well, no consistent differences were noted in the clinical outcomes of groups treated with PLF and PLIF.…”

“…Some authors consider the interbody fusion technique as being disadvantageous because it leads to excessive bleeding and is associated with prolonged operation time, [38] more extensive dissection and dural manipulation, and potential devastating complications such as end-plate erosion, cage displacement with neural component compression, and higher construct stiffness resulting in excessive load on adjacent segments. While these are the potential risks involved in circumferential vertebral arthrodesis, application of interbody cages for fusion results improvement of low-grade spondylolisthesis should have appropriate indications.…”

The Surgical Management of Low Grade Single Level Adult Degenerative Spondylolisthesis: Posterolateral Fusion versus Posterior Lumbar Interbody Fusion

“…There is very sparse evidence suggesting that the functional outcomes are better after anterior column support than other fusion models [5][6][7].…”